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Communication is a key competence for medical and nursing health care providers alike. However, there appear to be areas of "speechlessness" regarding specific medical problems, including the "taboo" disease incontinence. There is a lack of scientific data regarding incontinence in the context of communication among patients and health care professionals.The descriptive study was designed to provide insights how female and male patients alike perceive communications about incontinence with doctors and nurses, respectively. 22 structured interviews were conducted and taped with 16 elderly female and 6 male patients (age >/= 60 years, mean: 81 years, demented patients excluded, n = 19 analysable), and five interviews each with doctors and nurses within the setting of a rehabilitation hospital for geriatric patients (not reported here). We used published methodology to interpret the diversity of patients' verbal communications to the female interviewer.Results suggest that patients wish to find a relationship based on sympathy, empathy and trust. If incontinence is addressed, it is by doctors, not patients. Statements by patients suggest that they differentiate between expectations addressing the professional level of medical care, and a level perhaps best described as the quality of the personal relationship between the patient and doctor. However, these twofold expectations were not distinguishable regarding nursing professionals, they were perceived on a "personal care level" only, not the professional level regarding incontinence. Independent of professional affiliation, patients expect empathy, understanding, and respect. They selectively criticize manners of (some) nurses and lack of understandable transfer of information by doctors. The gender of the care providers was not an issue for patients regarding communication about incontinence. The preliminary results show that there is room for improvement for better communication regarding incontinence. However, areas affected appear to differ between nursing and medical professionals.

Cancer is one of the most frequent causes of death in Germany. The reasons of various cancer diseases still remain uncertain. There is a long-standing discussion about associations between personality, depression, stress, and stressful life events, respectively, and the development of malignant neoplasms. Evidence for a role of psychosocial factors in development of cancer is not unequivocal despite many years of research on the subject. Current prospective investigations do not support the conventional wisdom of a direct influence for personality in the development of cancer. Much of the research has been impaired by methodological flaws such as inadequate sample size, failure to adjust for potential confounders, lengths of follow-up, use of a variation of different measurements of cancer, and psychosocial variables. Furthermore, specific personality traits and various life events are associated with certain health-related behavior and lifestyle factors, e.g., smoking or an unhealthy nutrition. These unhealthy habits can increase cancer risk. Psychological parameters may alter immune and endocrine function and it has long been hypothesized that, through this pathway, psychosocial factors may affect cancer incidence. In conclusion, study results to substantiate the role of psychosocial factors in the development of various cancers are inconclusive. Contradictory results may be explained by methodological shortcomings. Further studies are required to pursue this question further.

Self-medication with OTC drugs is attracting attention in developed countries. This study examines prevalence and determinants of OTC drug use in a representative sample of German adults aged 18-79 years. A total of 7099 participants of the Drug Utilisation Survey were interviewed regarding drug use including OTC use within the last 7 days prior to the interview. This survey is a part of the representative German National Health Interview and Examination Survey 1998. Complete information is available from 3393 men and 3594 women: 17.6% of men and 10.8% of women use self-medicated OTC drugs exclusively, whereas 12.3% and 29.3%, respectively, use OTC drugs in addition to prescribed drugs. Besides sex, factors such as age, socioeconomic status and community size determine self-medication with OTC drugs. The most commonly used self-medicated OTC drugs are vitamins, minerals and analgesics. The most commonly reported indication for self-medication with OTC drugs is "prevention". Beside prescribed medication, self-medication with OTC drugs is an important part of drug usage for men and women in Germany. Health consciousness appears to be a significant factor to explain the prevalence OTC drug use.

The menopausal transition is a natural phase of every womańs life. Several symptoms emerging during the climacteric may be treated with estrogens. Hot flushes and symptoms of genital ageing may be relieved by estrogen therapy. Progestin therapy is indicated in all women with an intact uterus to avoid endometrial pathology. Given the present risk-benefit scenario, estrogen therapy is no longer a first-line choice to prevent osteoporosis. Counselling requires integration of recent knowledge provided by the first results of the Womeńs Health Initiative and other significant randomized, placebo-controlled, prospective clinical studies with clinically relevant outcomes, not the least unless good-quality data regarding other estrogens and progestins, apart from conjugated equine estrogens/medroxyprogesterone acetate are lacking. Women should be enabled to decide upon estrogen therapy after provision of extensive information by their physicians.

17 beta-estradiol, conjugated equine estrogens, esterified estrogens, and estriol constitute postmenopausal replacement therapy, all of which are in clinical use as oral preparations. Non-oral routes--matrix and reservoir patches, gel--were developed for estradiol, as was the intravaginal administration of estriol and estradiol. Daily doses of 1 mg estradiol(valerate) or 25 micrograms estradiol delivered via a patch or 0.5 mg gel or 0.3 mg conjugated equine estrogens are often sufficient to alleviate climacteric symptoms. Bone resorption may be effectively reduced and bone mineral density maintained by 1 mg estradiol or 25 micrograms transdermal estradiol. Maximal bone sparing dosages are 2 mg estradiol, 50 micrograms transdermal estradiol, 0.625 mg conjugated equine estrogens, and 1.25 mg estrone Estriol, predominantly used for the prevention and or treatment of urogenital symptoms, has no bone sparing effect at the doses in clinical use. Non-oral administration of estradiol may be superior in diabetic women and those with hypertriglyceridemia due to the different metabolism which does not mainly involve the hepatic first pass effect. Epidemiological data do not support any preference of oral versus non-oral routes of administration regarding side-effects such as venous thromboembolism. Progestogens--natural progesterone, derivatives structurally related to progesterone and testosterone, respectively--are necessary for endometrial protection. Sequential use of a progestogen for at least 10 days per month, preferably 12-14 days abolishes the increased incidence of endometrial hyperplasia which is likely to develop with unopposed use of estrogen. Observational studies do not suggest any superiority of a given progestogen regarding cardiovascular risk, prevention of osteoporosis, and cognitive function in postmenopausal women on estrogen replacement therapy. Tibolone, a derivative of norethindrone, is yet another option for replacement therapy. The recommended dose for treatment of climacteric symptoms and prevention of bone loss is 2.5 mg. Controlled clinical studies do not suggest that this compound is superior in achieving amenorrhea compared with continuous combined estrogen progestogen replacement therapy, as available data are inconsistent. In early postmenopause the sequential use of a progestogen in conjunction with an estrogen is the preferred treatment option. With advancing postmenopausal age either continuous combined replacement or tibolone may be choices in case withdrawal bleeding is no longer acceptable for women. However, there are no rigid age limit when to change treatments, the selection of which is largely influenced by the preference of the individual's acceptance of withdrawal bleeding.

At least one of four women will suffer from osteoporosis with fractures of vertebrae, forearm or hip. Maintenance of bone mass is a crucial argument for long-term estrogen replacement for prophylaxis of osteoporosis. 2 mg estradiol or 0.625 mg conjugated estrogens orally or 50 to 100 micrograms estradiol percutaneously are equally sufficient for prevention of osteoporosis. The additional use of a progestogen in women with intact uterus may support the antiresorptive effects of estrogens. Improvement of patients' compliance-administered today by only 25% of postmenopausal women in Germany through sufficient information upon estrogen replacement therapy provided by the medical community is a rewarding task for physicians and scientists engaged in the field of menopause and prevention of osteoporosis.

Quantitative CT of the axial skeleton (aQCT) may serve as an example of the evaluation and interpretation of bone densitometric data as it is the only state-of-the-art technique with valid longitudinal observations. The value of bone density measurements in interindividual cross sections refers to a grading derived from a representative reference population and provides an evaluation of fracture risk. The presence and rate of any bone loss can only be evaluated in an intraindividual longitudinal follow-up. Adequate follow-up for trabecular bone requires at least 3 to 5 years intervals to discriminate between different loss rates. Bone losses induced by steroid therapy or immobilisation may have faster kinetics apparent within months; bone density increase due to hormone substitution may be significant after one to two years. Morphological data allow critical evaluation of the quantitative measurements, eliminating false values and differentiating between rarefying and destructive osteopenia.

At least one of four women is suffering from osteoporosis with fractures of vertebrae, forearm or hip. Maintenance of bone-mass is a crucial argument for long-term estrogen replacement for prophylaxis of osteoporosis. 2 mg estradiol or 0.625 mg conjugated estrogens, or 50-100 micrograms estradiol percutaneously are equally sufficient for prevention of osteoporosis. The additional use of a progestagen in women with intact uterus may support the antiresorptive effects of estrogens. Improvement of patients' compliance of estrogen substitution--administered today in only 25% of postmenopausal women in Germany--by sufficient information upon estrogen replacement therapy provided by the medical community is an awarding task for physicians and scientists engaged in the field of menopause and prevention of osteoporosis.

Prophylaxis of postmenopausal osteoporosis is of major importance if estrogen replacement therapy is considered. Assessment of clinical symptoms, (standardized) x-ray analysis, and bone densitometry contribute to the final diagnosis. Incidence of osteoporotic fractures is rising due to alterations in life style and dietary habits. One out of three to four women eventually suffer from osteoporosis in the European countries, United States and Japan. Prevention of postmenopausal osteoporosis is achieved by adequate estrogen replacement therapy carried out for years, maintaining peripheral estradiol concentrations of 220 pmol/l. Doses of 2 mg estradiol or 0.625 mg of conjugated estrogen or 50-100 micrograms percutaneous estradiol/day are equally effective for prevention. The additional administration of a progestogen may be of specific value to increase the antiresorptive effect of estrogens. We distinguish between estrogen replacement in a cyclic or continuous way combined with a sequential or continuous progestogen in women with intact uterus.

The diagnostic ranking of trabecular morphology for the evaluation of osteoporosis in quantitative CT (QCT) is presented. 5 patterns of cancellous bone correlating with trabecular density may be discerned. However, these patterns may indicate osteoporotic changes in particular cases only, by confluent rarefactions if the density is still within the normal range. There is neither a predictive value for the degree of spontaneous or therapy-induced bone loss, nor for therapy response. The trabecular appearances remain unchanged in short term even under strong quantitative changes and are therefore of no value for follow-up.

Osteoporosis is a disease of the elderly characterized by a loss of bone mass causing fractures in presence of an inadequate trauma. Osteoporosis has to be considered as a significant ailment in our population. This review outlines epidemiology, pathogenesis and risk factors of primary osteoporosis. The physiological role of sex hormones, especially of estradiol, for the development and maintenance of skeletal bone mass is explained. Principles of preventive estrogen(-progesterone) application for the prophylaxis of postmenopausal osteoporosis are specified by several estrogen replacement studies in postmenopausal women. Individual replacement therapy for the compensation of a long-lasting estrogen deficit in the reproductive age group, in pre- and postmenopausal women is the assignment of the gynecologist in order to protect the skeletal system.

Idiopathic osteoporosis mainly affects postmenopausal women. The normal trabecular volume of the lumbar vertebrae in a sample of healthy perimenopausal women was established by monoenergetic computed tomography. Early diagnosis of diminished bone mass is crucial for the identification of women at risk for involuntary osteoporosis following climacteric estrogen depletion. Body weight, endogenous levels of sex steroids, renal calcium and hydroxyproline excretions are not related to individual bone mass in the lumbar spine.

The authors present a case of an interstitial extrauterine pregnancy in the intramural portion of the left oviduct after preceding ipsilateral adnectomy. Sonographic diagnosis was confirmed by the site at operation.

Healthy perimenopausal women (152) were examined by QCT to quantify the mineral content of the axial skeleton. The density was measured in the spongiosa of the L2-4, using single energy technique and the Cann-Genant calibration phantom. The women, aged 37 to 64, had no history of pathological fractures, ovariectomy, metabolic disease, or hormone therapy. The age-related mean values were 25 mg K2HP04/cm3 lower than the normal values reported by Genant et al. for 203 healthy American women. The 95% confidence interval was distinctly narrower (+/- 40 mg/cm3) than the American confidence interval (+/- 60 mg/cm3). To evaluate the relationship of the BMC to mechanical stress, the BMC was compared with body weight, body mass index (weight/height2), and the lumbar muscle mass estimated from cross sections of the paravertebral muscles in the CT images. The assumption that higher mechanical stress results in higher bone mineralization could not be confirmed.